Individual provider Active NPI

Jaden Labrake

  • Clinical Social Worker
  • Colorado Springs, CO
National Provider Identifier
1730924374
Registry record updated Jun 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SWC.0000001987 Issued in CO
Practice address
7075 Campus Dr Ste 202
Colorado Springs, CO 80920-6524
Phone
(719) 888-6827
NPI assigned
Jun 26, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X SWC.0000001987 CO Primary

Addresses

Primary practice location

7075 Campus Dr Ste 202
Colorado Springs, CO 80920-6524

Mailing address

7075 Campus Dr Ste 202
Colorado Springs, CO 80920-6524

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
SWC.0000001987COMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Polaris Wellness Group, PLLC CurrentSince Jun 30, 2024 Accepting new patients

Locations

7075 Campus Dr
Ste 202
Colorado Springs, CO 80920
Phone (719) 888-6827

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1719360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719360000000",
    "number": "1730924374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7075 CAMPUS DR STE 202",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809206524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7075 CAMPUS DR STE 202",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809206524",
            "telephone_number": "719-888-6827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LABRAKE",
        "first_name": "JADEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-26",
        "last_updated": "2024-06-26",
        "certification_date": "2024-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "SWC.0000001987",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.